Publications by authors named "Matthew Goldenberg"

39 Publications

Telepsychiatry: a Potential Force Against Climate Change.

Acad Psychiatry 2021 Apr 8. Epub 2021 Apr 8.

University of North Carolina School of Medicine, Chapel Hill, NC, USA.

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http://dx.doi.org/10.1007/s40596-021-01452-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032316PMC
April 2021

When Doctor Means Teacher: An Interactive Workshop on Patient-Centered Education.

MedEdPORTAL 2020 12 10;16:11053. Epub 2020 Dec 10.

Associate Professor, Department of Psychiatry, Yale University School of Medicine.

Introduction: Increasingly, health care is delivered through a patient-centered model, and patients engage in shared decision-making with their medical providers. As a result, medical educators are placing more emphasis on patient-centered communication skills. However, few published curricula currently offer a comprehensive discussion of skills for providing patient-centered education (PCE), a key component of shared decision-making. We developed an interactive, two-session workshop aiming to improve students' abilities to provide PCE.

Methods: Our workshop included didactic instruction, group discussion, and interactive simulations. The workshop was delivered to 50 clinical clerkship medical students. The first session concentrated on educating patients about their diagnoses, while the second session focused on providing patients with information about medications and other treatments. We used detailed and realistic role-play exercises as a core tool for student practice and demonstration of confidence. To evaluate the workshop, we used pre- and postsurveys.

Results: The sessions were well received by students, who strongly agreed both before and after the workshop that PCE was an important skill. Students also strongly agreed that the role-play exercises were an effective tool for learning PCE. They demonstrated significant improvements in their confidence to name important elements of PCE and to deliver PCE in the future.

Discussion: This workshop fills a curricular gap in offering a comprehensive and interactive curriculum for improving students' abilities to provide critical PCE. The format and content should be easily adaptable to various disciplines, learners, and teaching modalities.
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http://dx.doi.org/10.15766/mep_2374-8265.11053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732137PMC
December 2020

Emergency Department Psychiatric Observation Units: Good Care and Good Money?

Acad Emerg Med 2021 01 21;28(1):141-143. Epub 2020 Nov 21.

Department of Emergency Medicine, Yale University School of Medicine, Guilford, CT, USA.

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http://dx.doi.org/10.1111/acem.14167DOI Listing
January 2021

Suspending Medical Student Clerkships Due to COVID-19.

Med Sci Educ 2020 Jun 3:1-4. Epub 2020 Jun 3.

Office of Education, Yale University School of Medicine, New Haven, CT USA.

Medical schools around the world have been grappling with how to adapt undergraduate medical curricula in the face of the COVID-19 pandemic. Our institution made the decision to suspend all clinical clerkships the day before the Association of American Medical Colleges (AAMC) recommended to US medical schools a similar suspension of "medical student participation in any activities that involved patient contact." This manuscript describes the rapid evolution in our decision-making as we weighed various information, values, and priorities in the face of the emerging public health crisis. We discuss how a compromised learning environment and concerns about student, patient, and the public health led to the suspension. We also consider next steps as we move forward in this uncertain time.
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http://dx.doi.org/10.1007/s40670-020-00994-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266676PMC
June 2020

Being Reactive: Assessing Affect in the COVID-19 Era.

Acad Psychiatry 2020 Dec 5;44(6):682. Epub 2020 Aug 5.

University of North Carolina School of Medicine, Chapel Hill, NC, USA.

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http://dx.doi.org/10.1007/s40596-020-01293-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405928PMC
December 2020

Electroconvulsive Therapy: a Video-Based Educational Resource Using Standardized Patients.

Acad Psychiatry 2020 Oct 4;44(5):531-537. Epub 2020 Aug 4.

Yale School of Medicine, New Haven, CT, USA.

Objective: Video-based depictions of electroconvulsive therapy (ECT) can be useful for educational purposes, but many of the readily available resources may worsen already stigmatized views of the procedure. Educators' common reliance on such material highlights the paucity of equipoised depictions of modern ECT well suited for the training of health professionals. The authors developed and tested a new educational module enhanced by videotaped depictions of a simulated patient undergoing the consent, treatment, recovery, and follow-up phases of ECT.

Methods: The didactic intervention interspersed 7 short video clips (totaling 14 min) into a 55-min lecture on treatment-resistant depression. The session, part of an intensive course of preclinical psychiatry, was delivered online through synchronous videoconferencing with Zoom. The primary outcome measure was change in the Questionnaire on Attitudes and Knowledge of ECT (QuAKE).

Results: Fifty-three out of 63 (87%) eligible second-year medical students completed assessments at baseline and after exposure to the didactic intervention. QuAKE scores improved between baseline and endpoint: the Attitudes composite increased from 49.4 ± 6.1 to 59.1 ± 5.7 (paired t 10.65, p < 0.001, Cohen's d 0.69), and the Knowledge composite from 13.3 ± 1.2 to 13.9 ± 0.8 (paired t 3.97, p < 0.001, Cohen's d 0.23).

Conclusions: These video-based educational materials proved easy to implement in the virtual classroom, were amenable to adaptation by end-use instructors, were well received by learners, and led to measurable changes in students' knowledge of and attitudes toward ECT.
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http://dx.doi.org/10.1007/s40596-020-01292-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402389PMC
October 2020

Millennials in Psychiatry: Exploring Career Choice Factors in Generation Y Psychiatry Interns.

Acad Psychiatry 2020 Dec 13;44(6):727-733. Epub 2020 Jul 13.

Emory University School of Medicine, Atlanta, GA, USA.

Objective: There is a national shortage of psychiatrists. To grow the workforce, educators must understand the factors that influence the choice of psychiatry as a specialty for medical students in the Generation Y cohort.

Methods: Psychiatry residents born between 1981 and 2000 were recruited from six psychiatry training programs across the USA and were interviewed in the fall of their first year. The interviews were coded and analyzed qualitatively for themes. Career Construction Theory (CCT) was applied to relate the themes within the four domains of Career Adaptability (a focus of CCT): concern, control, curiosity, and confidence.

Results: The majority of themes mapped onto the four domains. A fifth domain, "contribution," was created to capture additional themes. Themes associated with choosing psychiatry as a career included Practice Concerns and Economic/Lifestyle Concerns (concern), Changes in Stigma and Changes in Legitimacy (control), Exploring Humanity and Exposures to Psychiatry (curiosity), Abilities Called Upon by the Field, Recognized Qualities in the Participant, and Recognized Qualities in the Faculty/Residents (confidence), and Hoping to Make a Difference and Engaging in Research/Technology (contribution).

Conclusions: With the knowledge generated from this study, educators now have a guide for the kinds of learning experiences that may attract Generation Y students to the field, and can identify those with the background, values, or personality traits most likely to find a career in psychiatry to be attractive.
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http://dx.doi.org/10.1007/s40596-020-01272-3DOI Listing
December 2020

Psychiatric emergency department volume during Covid-19 pandemic.

Am J Emerg Med 2021 Mar 1;41:233-234. Epub 2020 Jun 1.

Yale University School of Medicine, Department of Emergency Medicine, United States of America; Yale-New Haven Hospital, United States of America.

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http://dx.doi.org/10.1016/j.ajem.2020.05.088DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263232PMC
March 2021

Outcomes of Physicians with Substance Use Disorders in State Physician Health Programs: A Narrative Review.

J Psychoactive Drugs 2020 Jul-Aug;52(3):195-202. Epub 2020 Mar 11.

Department of Psychiatry and Biobehavioral Sciences, UCLA , Los Angeles, CA, USA.

The prevalence rate of addiction among physicians is similar to the general population, with approximately 10% to 12% of U.S.-based physicians developing substance use disorders (SUDs) during their lifetimes. To address this public health concern, physician health programs (PHPs) have been created to facilitate the early identification, evaluation, treatment, and monitoring of physicians. Although a number of published studies provide outcome information from PHPs, there has been no comprehensive review of the related literature. The objective of this narrative review is to summarize the treatment outcomes, including treatment types, rates of relapse, rates of contract completion or extension, as well as licensure and work status rates of a nationally representative physician cohort and related subpopulations from a single dataset. Based on the studies included in this review, our findings reveal that physicians who completed their PHP contracts have more favorable treatment outcomes than members of the general population who receive mainstream treatment. In addition, our review describes unique features of physician rehabilitation facilitated by PHPs. However, further prospective research is needed to ensure a standardized and comparable dataset and facilitate performance improvement.
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http://dx.doi.org/10.1080/02791072.2020.1734696DOI Listing
March 2020

ERASE-ing Patient Mistreatment of Trainees: Faculty Workshop.

MedEdPORTAL 2019 12 27;15:10865. Epub 2019 Dec 27.

Assistant Professor, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine.

Introduction: Mistreatment of physicians by patients is a long-standing phenomenon that has garnered increased attention recently. Medical students and residents also experience mistreatment, and many supervising physicians do not know how to recognize it or respond appropriately. Little guidance exists as to how faculty should best address these situations. We developed, taught, and evaluated a stepwise approach to help faculty physicians manage patient mistreatment of trainees (residents and students).

Methods: Our approach is summarized by the acronym ERASE: (1) Expect that mistreatment will occur. (2) Recognize episodes of mistreatment. (3) Address the situation in real time. (4) Support the learner after the event. (5) Establish/encourage a positive culture. We designed an interactive, case-based educator development session to teach ERASE and surveyed participants before and after to evaluate the session. Sixty-nine participants attended one of four workshops between November 2017 and January 2018.

Results: Nearly 80% of attendees reported having received no prior training in managing mistreatment of trainees by patients. Participants noted significant changes in their confidence in recognizing and responding to episodes of mistreatment after the session compared with just prior to it.

Discussion: ERASE fills an important void in medical education by introducing a novel, easy-to-understand approach that faculty can employ to manage mistreatment of trainees. We have continued to disseminate this model to faculty and residents in various departments around our medical center and at national conferences. This resource will allow educators to disseminate the ERASE model at their home institutions.
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http://dx.doi.org/10.15766/mep_2374-8265.10865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7012314PMC
December 2019

A Medical Student Is Psychiatrically Hospitalized.

Acad Psychiatry 2020 Oct 19;44(5):629-631. Epub 2019 Dec 19.

Yale University, New Haven, CT, USA.

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http://dx.doi.org/10.1007/s40596-019-01172-1DOI Listing
October 2020

Simulate to Stimulate: Manikin-Based Simulation in the Psychiatry Clerkship.

Acad Psychiatry 2020 Feb 18;44(1):82-85. Epub 2019 Oct 18.

Yale University School of Medicine, New Haven, CT, USA.

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http://dx.doi.org/10.1007/s40596-019-01111-0DOI Listing
February 2020

Didactic Broadway: Using Musical Theater in Psychiatric Education.

Acad Psychiatry 2019 Dec 15;43(6):621-623. Epub 2019 Oct 15.

Yale University, New Haven, CT, USA.

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http://dx.doi.org/10.1007/s40596-019-01118-7DOI Listing
December 2019

Just Admit It: We Should Stop Using the Word Admit.

Acad Psychiatry 2019 12 27;43(6):656. Epub 2019 Aug 27.

Yale University, New Haven, CT, USA.

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http://dx.doi.org/10.1007/s40596-019-01103-0DOI Listing
December 2019

ERASE: a New Framework for Faculty to Manage Patient Mistreatment of Trainees.

Acad Psychiatry 2019 Aug 6;43(4):396-399. Epub 2018 Dec 6.

Yale University School of Medicine, New Haven, CT, USA.

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http://dx.doi.org/10.1007/s40596-018-1011-6DOI Listing
August 2019

Opening of Psychiatric Observation Unit Eases Boarding Crisis.

Acad Emerg Med 2018 04 1;25(4):456-460. Epub 2018 Feb 1.

Department of Emergency Medicine, New Haven, CT.

Objectives: The objective of this study was to evaluate the effect of a psychiatric observation unit in reducing emergency department (ED) boarding and length of stay (LOS) for patients presenting with primary psychiatric chief complaints. A secondary outcome was to determine the effect of a psychiatric observation unit on inpatient psychiatric bed utilization.

Methods: This study was a before-and-after analysis conducted in a 1,541-bed tertiary care academic medical center including an adult ED with annual census over 90,000 between February 2013 and July 2014. All adult patients (age > 17 years) requiring evaluation by the acute psychiatry service in the crisis intervention unit (CIU) within the ED were included. Patients who left without being seen, left against medical advice, or were dispositioned to the pediatric hospital, hospice, or court/law enforcement were excluded. In December 2013, a 12-bed locked psychiatric observation unit was opened that included dedicated behavioral health staff and was intended for psychiatric patients requiring up to 48 hours of care. The primary outcomes were ED LOS, CIU LOS, and total LOS. Secondary outcomes included the hold rate defined as the proportion of acute psychiatry patients requiring subsequent observation or inpatient admission and the inpatient psychiatric admission rate. For the primary analysis we constructed ARIMA regression models that account for secular changes in the primary outcomes. We conducted two sensitivity analyses, first replicating the primary analysis after excluding patients with concurrent acute intoxication and second by comparing the 3-month period postintervention to the identical 3-month period of the prior year to account for seasonality.

Results: A total of 3,501 patients were included before intervention and 3,798 after intervention. The median ED LOS for the preintervention period was 155 minutes (interquartile range [IQR] = 19-346 minutes), lower than the median ED LOS for the postintervention period of 35 minutes (IQR = 9-209 minutes, p < 0.0001). Similar reductions were observed in CIU LOS (865 minutes vs. 379 minutes, p < 0.0001) and total LOS (1,112 minutes vs. 920 minutes, p = 0.003). The psychiatric hold rate was statistically higher after intervention (before = 42%, after = 50%, p < 0.0001), however, coupled with a statistically lower psychiatric admission rate (before = 42%, after = 25%, p < 0.0001).

Conclusions: Creation of an acute psychiatric observation improves ED and acute psychiatric service throughput while supporting the efficient allocation of scare inpatient psychiatric beds. This novel approach demonstrates the promise of extending successful observation care models from medical to psychiatric illness with the potential to improve the value of acute psychiatric care while minimizing the harms of ED crowding.
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http://dx.doi.org/10.1111/acem.13369DOI Listing
April 2018

Integration of Primary Care and Psychiatry: A New Paradigm for Medical Student Clerkships.

J Gen Intern Med 2018 01 28;33(1):120-124. Epub 2017 Aug 28.

Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.

Background: Public health crises in primary care and psychiatry have prompted development of innovative, integrated care models, yet undergraduate medical education is not currently designed to prepare future physicians to work within such systems.

Aim: To implement an integrated primary care-psychiatry clerkship for third-year medical students.

Setting: Undergraduate medical education, amid institutional curriculum reform.

Participants: Two hundred thirty-seven medical students participated in the clerkship in academic years 2015-2017.

Program Description: Educators in psychiatry, internal medicine, and pediatrics developed a 12-week integrated Biopsychosocial Approach to Health (BAH)/Primary Care-Psychiatry Clerkship. The clerkship provides students clinical experience in primary care, psychiatry, and integrated care settings, and a longitudinal, integrated didactic series covering key areas of interface between the two disciplines.

Program Evaluation: Students reported satisfaction with the clerkship overall, rating it 3.9-4.3 on a 1-5 Likert scale, but many found its clinical curriculum and administrative organization disorienting. Students appreciated the conceptual rationale integrating primary care and psychiatry more in the classroom setting than in the clinical setting.

Conclusions: While preliminary clerkship outcomes are promising, further optimization and evaluation of clinical and classroom curricula are ongoing. This novel educational paradigm is one model for preparing students for the integrated healthcare system of the twenty-first century.
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http://dx.doi.org/10.1007/s11606-017-4169-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756162PMC
January 2018

Stability of and Factors Related to Medical Student Specialty Choice of Psychiatry.

Am J Psychiatry 2017 09 16;174(9):859-866. Epub 2017 Jun 16.

From the Department of Psychiatry, Yale University School of Medicine, New Haven, Conn.; and the Departments of Biostatistics and Psychiatry, University of Arkansas for Medical Sciences, Little Rock.

Objective: Targeted efforts are needed to increase the number of medical students choosing psychiatry, but little is known about when students decide on their specialty or what factors influence their choice. The authors examined the timing and stability of student career choice of psychiatry compared with other specialties and determined what pre- and intra-medical school factors were associated with choosing a career in psychiatry.

Method: Using survey data from students who graduated from U.S. allopathic medical schools in 2013 and 2014 (N=29,713), the authors computed rates of psychiatry specialty choice at the beginning and end of medical school and assessed the stability of that choice. A multivariate-adjusted logistic regression and recursive partitioning were used to determine the association of 29 factors with psychiatry specialty choice.

Results: Choice of psychiatry increased from 1.6% at the start of medical school to 4.1% at graduation. The stability of psychiatry specialty choice from matriculation to graduation, at just over 50%, was greater than for any other specialty. However, almost 80% of future psychiatrists did not indicate an inclination toward the specialty at matriculation. A rating of "excellent" for the psychiatry clerkship (odds ratio=2.66), a major in psychology in college (odds ratio=2.58), and valuing work-life balance (odds ratio=2.25) were the factors most strongly associated with psychiatry career choice.

Conclusions: Students who enter medical school planning to become psychiatrists are likely to do so, but the vast majority of students who choose psychiatry do so during medical school. Increasing the percentage of medical students with undergraduate psychology majors and providing an exemplary psychiatry clerkship are modifiable factors that may increase the rate of psychiatry specialty choice.
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http://dx.doi.org/10.1176/appi.ajp.2017.17020159DOI Listing
September 2017

Overcoming Barriers to Initiating Medication-assisted Treatment for Heroin Use Disorder in a General Medical Hospital: A Case Report and Narrative Literature Review.

J Psychiatr Pract 2017 05;23(3):221-229

HASSAMAL: Department of Addiction Psychiatry, UCLA Kern, Bakersfield, CA GOLDENBERG: Department of Addiction Psychiatry, UCLA San Fernando Valley/VA Greater Los Angeles, Sepulveda, CA ISHAK: Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, and David Geffen School of Medicine at UCLA, Semel Institute of Neuroscience and Human Behavior, Los Angeles, CA HAGLUND and DANOVITCH: Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA MIOTTO: David Geffen School of Medicine at UCLA, Semel Institute of Neuroscience and Human Behavior, Los Angeles, CA.

Deaths due to heroin overdoses are increasing and are the leading cause of death among intravenous heroin users. Although medication-assisted treatment (MAT) improves morbidity and mortality in patients with opioid use disorders, it is underutilized. Most efforts to expand access to MAT have focused on outpatient settings. Although the inpatient medical setting presents a critical opportunity to initiate treatment, general hospitals are often unfamiliar with MAT, creating a number of barriers to its use. In this report, we describe the case of a woman with heroin use disorder who was initiated on buprenorphine maintenance treatment while hospitalized for cardiac disease related to her intravenous heroin use. Barriers to initiating buprenorphine in this case included patient, practitioner, and organizational factors, and, ultimately, shared misperceptions about the feasibility of administering buprenorphine in a general medical hospital. These barriers were addressed, buprenorphine was initiated, and the patient demonstrated reduced craving, improved postoperative pain control, improved overall well-being, increased engagement in discharge planning, and acceptance of referral for addiction specialty aftercare. Our experience with this patient suggests that it is feasible to initiate buprenorphine in acute medical settings and that such treatment can improve patient outcomes. Our review of the literature reveals emerging evidence supporting the value of this practice.
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http://dx.doi.org/10.1097/PRA.0000000000000231DOI Listing
May 2017

The impact of cannabis and cannabinoids for medical conditions on health-related quality of life: A systematic review and meta-analysis.

Drug Alcohol Depend 2017 05 1;174:80-90. Epub 2017 Mar 1.

Cedars-Sinai Medical Center, Los Angeles, CA, United States.

Introduction: The use of cannabis or cannabinoids to treat medical conditions and/or alleviate symptoms is increasingly common. However, the impact of this use on patient reported outcomes, such as health-related quality of life (HRQoL), remains unclear.

Methods: We conducted a systematic review and meta-analysis, employing guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We categorized studies based on design, targeted disease condition, and type of cannabis or cannabinoid used. We scored studies based on quality and risk of bias. After eliminating some studies because of poor quality or insufficient data, we conducted meta-analyses of remaining studies based on design.

Results: Twenty studies met our pre-defined selection criteria. Eleven studies were randomized controlled trials (RCTs; 2322 participants); the remaining studies were of cohort and cross-sectional design. Studies of cannabinoids were mostly RCTs of higher design quality than studies of cannabis, which utilized smaller self-selected samples in observational studies. Although we did not uncover a significant association between cannabis and cannabinoids for medical conditions and HRQoL, some patients who used them to treat pain, multiple sclerosis, and inflammatory bower disorders have reported small improvements in HRQoL, whereas some HIV patients have reported reduced HRQoL.

Conclusion: The relationship between HRQoL and the use of cannabis or cannabinoids for medical conditions is inconclusive. Some patient populations report improvements whereas others report reductions in HRQoL. In order to inform users, practitioners, and policymakers more clearly, future studies should adhere to stricter research quality guidelines and more clearly report patient outcomes.
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http://dx.doi.org/10.1016/j.drugalcdep.2016.12.030DOI Listing
May 2017

Undergraduate Neuroscience Majors: A Missed Opportunity for Psychiatry Workforce Development.

Acad Psychiatry 2017 Apr 10;41(2):239-242. Epub 2017 Feb 10.

Yale University School of Medicine, New Haven, CT, USA.

Objective: This study sought to determine whether and to what extent medical students with an undergraduate college major in neuroscience, relative to other college majors, pursue psychiatry relative to other brain-based specialties (neurology and neurosurgery) and internal medicine.

Methods: The authors analyzed data from AAMC matriculation and graduation surveys for all students who graduated from US medical schools in 2013 and 2014 (n = 29,714). Students who majored in neuroscience, psychology, and biology were compared to all other students in terms of their specialty choice at both time points. For each major, the authors determined rates of specialty choice of psychiatry, neurology, neurosurgery, and, for comparison, internal medicine. This study employed Chi-square statistic to compare odds of various specialty choices among different majors.

Results: Among medical students with an undergraduate neuroscience major (3.5% of all medical students), only 2.3% preferred psychiatry at matriculation, compared to 21.5% who chose neurology, 13.1% neurosurgery, and 11% internal medicine. By graduation, psychiatry specialty choice increased to 5.1% among neuroscience majors while choice of neurology and neurosurgery declined. Psychology majors (OR = 3.16, 95% CI 2.60-4.47) but not neuroscience majors (OR 1.28, 0.92-1.77) were more likely than their peers to choose psychiatry.

Conclusions: Psychiatry struggles to attract neuroscience majors to the specialty. This missed opportunity is an obstacle to developing the neuroscience literacy of the workforce and jeopardizes the neuroscientific future of our field. Several potential strategies to address the recruitment challenges exist.
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http://dx.doi.org/10.1007/s40596-017-0670-zDOI Listing
April 2017

Missing the point: self-inflicted traumatic brain injury in psychosis.

BMJ Case Rep 2016 Dec 21;2016. Epub 2016 Dec 21.

Department of Emergency Medicine, Yale University, New Haven, Connecticut, USA.

A 36-year-old man was brought to the emergency department by emergency medical services after being found acting unusually at a gas station with blood on his head and clothing. He presented acutely psychotic and reported that he had a pen in his head. Medical evaluation was notable for a superficial puncture wound to the right temple, and he was medically cleared for psychiatric evaluation. After he developed nausea and headache later that evening, the CT scan revealed a temporal bone fracture, pneumocephalus, intraparenchymal haemorrhage and the presence of a metal pen tip lodged in the brain parenchyma. The full nature of the injury went undiscovered in the emergency department for 16 hours due to the superficial appearance of the injury and his acute psychosis with prominent delusional thought content and disorganisation. He underwent craniotomy with removal of the pen and subsequent hospitalisation for intravenous antibiotics, followed by a prolonged psychiatric hospitalisation for psychosis.
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http://dx.doi.org/10.1136/bcr-2016-216767DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5237792PMC
December 2016

Quality of life and recreational cannabis use.

Am J Addict 2017 Jan 21;26(1):8-25. Epub 2016 Dec 21.

Cedars-Sinai Medical Center, Los Angeles, California.

Introduction: Cannabis is now the most commonly used illicit drug in the United States and use is increasing. Frequent cannabis use has been associated with adverse social and health effects. We sought to evaluate the relationship between recreational cannabis use and Quality of Life (QoL), a person-centered measure that characterizes the overall sense of health and wellbeing. We hypothesized that QoL would be unchanged or increased among recreational cannabis users, who did not meet criteria for a Cannabis Use Disorder (CUD) and that QoL would be lower among those who met criteria for a CUD.

Methods: We conducted a systematic review, employing guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The results were categorized into tables and identified trends.

Results: Fourteen studies met our pre-defined selection criteria. The studies were heterogeneous and their quality was low. With one exception, we did not identify any population for whom cannabis use was associated with improved QoL. QoL was lower in persons who used cannabis heavily, or who met criteria for CUD. However, this association was inconsistent and the magnitude was weaker than the relationship between QoL and use of other addictive substances (including tobacco and illicit drugs).

Conclusion: In this systematic review, heavy cannabis use or CUD was associated with reduced QoL. It is unknown whether reduced QoL drives cannabis use, or whether cannabis use can lead to reduced QoL. Prospective studies are needed to evaluate the causal relationship between cannabis and QoL.

Scientific Significance: Furthering the understanding of the relationship between cannabis and QoL can inform public policy, prevention efforts, outcomes, and an objective understanding of the effects of cannabis users. (Am J Addict 2017;26:8-25).
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http://dx.doi.org/10.1111/ajad.12486DOI Listing
January 2017

Democratic and Republican physicians provide different care on politicized health issues.

Proc Natl Acad Sci U S A 2016 10 3;113(42):11811-11816. Epub 2016 Oct 3.

Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510.

Physicians frequently interact with patients about politically salient health issues, such as drug use, firearm safety, and sexual behavior. We investigate whether physicians' own political views affect their treatment decisions on these issues. We linked the records of over 20,000 primary care physicians in 29 US states to a voter registration database, obtaining the physicians' political party affiliations. We then surveyed a sample of Democratic and Republican primary care physicians. Respondents evaluated nine patient vignettes, three of which addressed especially politicized health issues (marijuana, abortion, and firearm storage). Physicians rated the seriousness of the issue presented in each vignette and their likelihood of engaging in specific management options. On the politicized health issues-and only on such issues-Democratic and Republican physicians differed substantially in their expressed concern and their recommended treatment plan. We control for physician demographics (like age, gender, and religiosity), patient population, and geography. Physician partisan bias can lead to unwarranted variation in patient care. Awareness of how a physician's political attitudes might affect patient care is important to physicians and patients alike.
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http://dx.doi.org/10.1073/pnas.1606609113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5081578PMC
October 2016

Analysis of Patient-reported Outcomes of Quality of Life and Functioning Before and After Treatment of Major Depressive Disorder Comorbid With Alcohol Use Disorders.

J Addict Med 2017 Jan/Feb;11(1):47-54

Department of Psychiatry and Behavioral Neurosciences (ID, AJS, AK, MG, MH, BV, JD, WWI), Cedars-Sinai Medical Center; Department of Psychiatry and Biobehavioral Sciences (WWI), David Geffen School of Medicine, University of California; Department of Psychology (AJS), California School of Professional Psychology at Alliant International University; Biostatistics Core (JM), Research Institute and Clinical & Translational Science Institute (CTSI), Cedars-Sinai Medical Center, Los Angeles, CA; and Department of Psychological Sciences (KC), Purdue University, West Lafayette, IN.

Objective: Alcohol use disorders (AUDs) are common among persons with major depressive disorder (MDD) and have an adverse impact on course of illness and patient outcomes. The aim of this study was to examine whether AUD adversely impacted patient-centered outcomes in a sample of research subjects evaluated as part of a large clinical trial for depression. The outcomes of interest to this post hoc analysis are quality of life (QOL), functioning, and depressive symptom severity.

Methods: We analyzed 2280 adult MDD outpatient research subjects using data from the Sequenced Treatment Alternatives to Relieve Depression trial. We compared entry and post-selective serotonin reuptake inhibitors (SSRI) treatment QOL, functioning, and depressive symptom severity scores between 121comorbid MDD with AUD (MDD + AUD) subjects and 2159 MDD-no-AUD subjects, and also differences between subjects categorized as remitters versus nonremitters within each group at exit.

Results: At entry, MDD + AUD subjects reported similar QOL, functioning, and depressive symptom severity compared with the MDD-no-AUD subjects. After treatment with citalopram, both groups showed significant improvements throughout treatment; however, 36% to 55% of subjects still suffered from severely impaired QOL and functioning at exit.

Conclusions: The overall study population demonstrated a significant response to treatment with large effect sizes in depressive symptom reduction, but to a lesser extent in QOL and functioning. Findings suggest that subjects with MDD + AUD benefited equally as MDD-no-AUD from treatment with selective serotonin reuptake inhibitors (SSRI) medication, yet both groups continue to experience reduced QOL and functioning after treatment. Monitoring QOL and functioning is critical to determine whether interventions that improve clinical outcomes also impact patient-centered outcomes, and our analysis suggests that there is a pressing need for innovative interventions that effectively improve these outcomes.
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http://dx.doi.org/10.1097/ADM.0000000000000268DOI Listing
October 2017

Mental health training for health workers in Africa: a systematic review.

Lancet Psychiatry 2016 Jan;3(1):65-76

Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London, UK.

Commitment to building mental health treatment capacity in Africa is increasing but little agreement exists on strategies to train health workers on mental health or evaluation of training efforts. We systematically reviewed published literature on interventions to train health-care workers in Africa on mental health. 37 studies met our inclusion criteria. Training outcomes focused on changes in knowledge and attitude, with few studies evaluating skill and practice and only two studies measuring clinical outcomes. Quality of study methodology was generally not high, with scarce follow-up data and use of control cohorts. Existing studies provide examples of many training and evaluation strategies, but evidence to draw conclusions about the efficacy of different training techniques is inadequate. Key knowledge gaps include development and testing of innovative educational strategies; development of standardised, competency-based learning objectives and outcome measures; and training that facilitates implementation of integrated mental health systems. African institutions need to be empowered to do research in these areas to encourage the development of best practices for the continent.
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http://dx.doi.org/10.1016/S2215-0366(15)00379-XDOI Listing
January 2016

House Calls: Physicians in the US Congress, 2005-2015.

South Med J 2015 Nov;108(11):657-61

From the Department of Psychiatry, Yale University, New Haven, Connecticut.

Objectives: Physicians occupy a prominent position in the US healthcare system, and physicians who serve in Congress may bring a particular perspective, expertise, and influence to health-related legislation. The purpose of this study was to describe physician membership in the US Congress between 2005 and 2015.

Methods: Congressional biographical records were searched to identify physicians who served in the US Congress from 2005 to 2015. Political and demographic characteristics of physician-members were compared with those of nonphysician-members of Congress and of all US physicians. The numbers of physicians in recent Congresses also were compared with those in each Congress since 1945.

Results: A total of 27 physicians representing 17 states have served in Congress since 2005. There has been a significant increase in physician representation since 1987, reaching a high of 20 members (3.7%) in the Congresses immediately following passage of the Patient Protection and Affordable Care Act. Physician-members were mostly men (93%) and more likely than their Congressional colleagues to be Republican (78% vs 53% of all members, P = 0.007) and from the South (63% vs 35% of all members, P = 0.003). Compared with physicians in general, physicians in Congress were more likely to be men (93% vs 70%, P = 0.009) and surgeons (26% vs 11%, P = 0.01).

Conclusions: Physician representation in Congress has increased substantially since 2000, potentially reflecting the greater political prominence of healthcare issues, as well as increased interest by and recruitment of physician-candidates. Physicians in Congress differ from their colleagues and from physicians in general in various demographic and political characteristics.
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http://dx.doi.org/10.14423/SMJ.0000000000000366DOI Listing
November 2015

Quality of life and smoking.

Am J Addict 2014 Nov-Dec;23(6):540-62. Epub 2014 Sep 25.

Banner Good Samaritan Medical Center, Phoenix, Arizona.

Background And Objectives: Smoking tobacco is the leading cause of preventable illness in the United States and around the world. However, much remains unknown about the factors that motivate individuals to smoke. Quality of life (QoL) has become an important measure of outcomes across all medical specialties, in both research and clinical settings. To date, there has not been a critical review of the research relevant to QoL in smokers. In this review, we describe which scales are used to quantify the QoL of smokers, the relationship between smoking and QoL and the positive impact of smoking cessation.

Methods: Fifty-four relevant studies are included in our review.

Results: Low QoL and depression are associated with higher odds of smoking initiation and lower odds of successful smoking cessation. There is a negative relationship between smoking and QoL and the magnitude of this association is related to the number of cigarettes smoked. Secondhand smoke also appears to be negatively associated with QoL. Smoking cessation significantly improves QoL. These findings have been replicated across populations with diverse socioeconomic and cultural groups around the world.

Discussion And Conclusions: QoL data promotes smokers and practitioners to become more sensitive to the sub-clinical adverse effects of cigarette smoking, thereby improving motivation to quit, cessation rates, and treatment outcomes.

Scientific Significance: Understanding the relationship between QoL and tobacco smoking is important for patients, clinicians, and researchers.
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http://dx.doi.org/10.1111/j.1521-0391.2014.12148.xDOI Listing
June 2015